Release Form Mission Street Tattoo

Name*

First NameLast Name

Phone Number*

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Email*

example@example.com

Birthdate

I acknowledge by signing this release form that I have been given the full opportunity to ask any and all questions I might have about obtaining a tattoo from Mission Street Tattoo. I acknowledge that all my questions have been answered to my full and total satisfaction. I specifically acknowledge that the procedure has been described to me, and I have been advised of the facts and matters set forth below, and I agree as follows. Read, check all boxes, and sign.*

I am not under the influence of alcohol or drugs.I do not have acne, freckles, moles, or sunburn in the area to be tattooed that might be agitated by the tattoo process (healing excluded).I have reviewed my design, checked the spelling if applicable, and give my full consent to the application of my tattoo.I acknowledge that I am not pregnant.I understand that the procedure will involve the following steps. The area of my body to be tattooed will be cleaned and shaved. A stencil of the design for the tattoo will be applied, and then the design will be made permanent by using needles to insert ink into the skin.I acknowledge that I have truthfully represented to the associates, agents and representatives of Mission Street Tattoo that I am over eighteen (18) years of age.I acknowledge it is not reasonably possible for the associates, agents and representatives of Mission Street Tattoo to determine whether I might have an allergic reaction to the dyes, pigments, or processes used in my tattoo, and I agree to accept that such risks are possible. The inks used in tattooing are not FDA approved.I acknowledge that infection is always possible as a result of obtaining a tattoo particularly in that event that I do not take proper care of my tattoo.I acknowledge receipt of written instructions advising me of proper care of my tattoo and recognize the absolute necessity of following those written instructions.I acknowledge that variations in color and design may exist between any tattoos as selected by me and as ultimately applied to my body.I acknowledge that tattooing is a permanent change to my appearance and that no representations have been made to me as to the ability to later change, alter or remove my tattoo.I acknowledge that the obtaining of my tattoo is my choice alone and I consent to the application of the tattoo, and to any actions or conduct of the associates, agents or representatives of Mission Street Tattoo that are reasonably necessary to perform the tattoo procedure.I agree to release and forever discharge and forever hold harmless Mission Street Tattoo and its associates, agents officers and shareholders from any and all claims, damages, or legal actions arising from or connected in any way with my tattoo or the procedures and conduct used to apply my tattoo and any and all tattoos applied by Mission Street Tattoo and its associates, agents and representatives in the future.

I have been fully informed of the risks of tattooing including but not limited to infection, scarring, difficulties in detecting melanoma, and allergic reactions to tattoo pigment, latex gloves, and antibiotics. Having been informed of the potential risks associated with getting a tattoo, I still wish to proceed with tattoo application and I assume any and all risks that may arise from tattooing.

Signature*

Date*

Please upload an image of your Drivers License, State Identification , or Passport*

Release Form

Medical History